Introduction

The Covid-19 pandemic continues to highlight inequality in health outcomes in the United States. As of April 23rd, 2021, the CDC reports that Hispanic, Black, and American Indian or Alaska Native people are more likely to test positive for, be hospitalized for, and die from Covid-19 when compared to white, non-Hispanic people. Considering these disparities alongside recent developments in vaccine distribution, we became curious as to how race and ethnicity relate to immunization rates in each state.

Various data sources have presented vaccination progress in terms of each state’s efficiency (use of allocated vaccines) and speed (proportion of population that is vaccinated). We have developed a range of visualizations to consider how race and ethnicity relate to vaccine progress in the United States.

Are states vaccinating demographic groups proportionally to their share of the population?

One of our goals was to make a visualization to see whether demographic groups were receiving their share of Covid-19 vaccines. We present this using a Hexbin map, a 2-D density technique where each state is represented with a hexagon, following an example by Yan Holtz of The R Graph Gallery. The Kaiser Family Foundation (KFF) collects data on the percentage of vaccines that have been distributed to six racial and ethnic group. They began publishing this on March 1, 2021 and have recently been re-publishing this weekly. KFF also maintains a dataset of population distribution by race and ethnicity in each state. We developed a “demographic metric” comparing these two values to be able to indicate whether demographic groups were receiving a proportionate share of vaccinations:

To make this value easier to interpret, we set cutoff values such that demographic metrics were categorized (and colored accordingly) into extremely below share, below share, proportionate share, above share, and extremely above share.

The KFF data begins on March 1st, when states had varying restrictions regarding vaccine eligibility, and spans several weeks past April 19th, the date when all adults became eligible in every US state. This Shiny App (link) allows users to select a demographic group and date of interest.

Looking at each demographic group, we can observe some shifts in the number of states (51 including D.C.) reporting data by race and ethnicity (from March 1st to May 10th) as well as vaccine distribution proportionality:

Does vaccine hesitancy explain inequity in distribution?

We also wanted to measure to what extent people’s hesitation to get the vaccine has affected lack of vaccinations by racial groups on a national scale. Using data from both KFF for vaccinations and the Morning Consult for hesitancy, we created a bar chart that compares the percentage of people in each racial group that reported that they were either uncertain or unwilling to get the vaccine with the percentage that have not been vaccinated. To further compare these values, we also added a ratio that accounts for the percentage of people who are hesitant to get vaccinated out of those who aren’t vaccinated, again by racial group.

ggplot(bardata1, 
       aes(fill=measure, 
           y=value, 
           x=race)) + 
    geom_bar(position="dodge", 
             stat="identity") + 
  scale_fill_brewer(palette = "Set2") +
  labs( 
    title = "Does vaccine hesitancy account for lack of vaccinations among racial groups?", 
    y = "Percentage",  
    x = "Race", 
    fill = "Measure")

Here, we see that Black Americans are most hesitant to get the vaccine, followed by Hispanics, and then White. This makes sense given the history of racial discrimination in the healthcare system that has, understandingly, led to a general distrust of government led health initiatives. It is also worth noting that the percentage of non vaccinated people by racial group shows the same trend, with Blacks having the highest and whites the lowest. This suggests that there could be a correlation between the two measures, but it could be more useful to analyze what percentage of non vaccinated people said they were hesitant to get the vaccine. By dividing the hesitant percentage by the non vaccinated percentage, we are able to do this.

Ratio values for Black and White Americans is fairly high, indicating that a majority of those who wish to get vaccinated from those groups are able to do so. For Hispanic Americans, the ratio is slightly lower, which shows that about half of Hispanics who are not hesitant to get the vaccine still have not been vaccinated. This aligns with our previous data, as the demographic metric for Hispanics seemed to be lower than that for Black and White people. Some factors that could contribute to this difference may lie in the fact that out of these 3 groups, Hispanics are more likely to be immigrants, so language and citizenship barriers are present. However, we also have to keep in mind that age and other factors such as predisposed conditions have allowed some to get vaccinated earlier than others, so a percentage of those not vaccinated and not hesitant simply could have not been eligible at the time we collected our data.

Considering vaccine distribution and COVID-19 cases at the county level

texas_vax_map

References

CDC. (2021, April 23). Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

Galewitz, P. (2021, April 5). Vermont to Give Minority Residents Vaccine Priority. Kaiser Health News. https://khn.org/news/article/vermont-gives-blacks-and-other-minority-residents-vaccine-priority/

Holtz, Y. (n.d.). Hexbin map in R: an example with US states. The R Graph Gallery. Retrieved May 17, 2021, from https://www.r-graph-gallery.com/328-hexbin-map-of-the-usa.html

Kaiser Family Foundation. (n.d.). COVID-19 Vaccinations by Race/Ethnicity. Retrieved May 17, 2021, from https://www.kff.org/other/state-indicator/covid-19-vaccinations-by-race-ethnicity/

Kaiser Family Foundation. (2020, October 23). Population Distribution by Race/Ethnicity. https://www.kff.org/other/state-indicator/distribution-by-raceethnicity/

Kaiser Family Foundation. (2021, May 12). Percent of Total Population that has Received a COVID-19 Vaccine by Race/Ethnicity. https://www.kff.org/other/state-indicator/percent-of-total-population-that-has-received-a-covid-19-vaccine-by-race-ethnicity/

Laughlin, N. (2021, May 13). Vaccine Opposition Closely Mirrors Trump Vote by State; Pace of Vaccinations Stalls Among Young Adults. Morning Consult. https://morningconsult.com/covid19-vaccine-dashboard/